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PubMed1982

Thoracic and cardiovascular surgery in Singapore.

Thoracic and Cardiovascular Surgery started in Singapore on the initiative of a number of the leading general surgeons working in general surgical units in the public institutions. Initially, only thoracic surgery was done. This was followed about 15 years later with cardiovascular surgery. A decision was made to establish a Thoracic Surgical Unit at the Tan Tock Seng Hospital in 1965. The Head of Department was appointed. Space had become available at this hospital following the very successful anti-tuberculosis chemotherapy programme. The department was set up in December 1966. It grew steadily over the years. As in other similar centres, the spectrum of patients that underwent operations in the department became predominantly cardiovascular in nature. In December 1981, this department was transferred to the Singapore General Hospital where specialised facilities based on the experience of the surgical team had been installed.

Cardiac Surgical Procedures↗
PubMed2006

Comorbidity in newly diagnosed thyroid cancer patients: a population-based study on prevalence and the impact on treatment and survival.

BACKGROUND: Comorbidity may be an important contributory factor to differences in the treatment and outcome of cancer, especially in older patients. It might also provide information on the aetiology of the cancer in cases of high or low frequency. The aim of this study was to describe the spectrum of comorbidity and the possible impact on treatment and survival in newly diagnosed thyroid cancer (TC). DESIGN: A population-based observational study. SETTING: The Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), the Netherlands. METHODS: Demographic, histological and treatment data on all 417 TC patients diagnosed between 1 January 1993 and 31 December 2002 were collected and followed up till 2004. An adapted version of the list of Charlson was used for registration of clinically relevant concomitant disorders. The prevalence of comorbidity at diagnosis was analysed according to gender, age, histological type and therapy. Crude 6-month and 1- and 5-year survival rates were determined. A regression analysis was performed to identify independent variables related to survival. RESULTS: Information on comorbidity was available for 378 patients (91%). Comorbidity was present in 32% of the patients; 23% had one and 12% had two or more concomitant diseases. The prevalence of comorbidity increased with age. Hypertension was the most frequent comorbidity (18%), followed by 'other cancers' (7%), cardiovascular diseases (6%) and diabetes mellitus (6%). The prevalence of hypertension was twice as high as expected at all age groups. Six patients > 60 years had had tuberculosis. Initial surgical treatment was negatively related to the presence of concomitant diseases in patients < 70 years (P = 0.02), but not in patients > or = 70 years. Comorbidity was not independently associated with crude survival up to 5 years. CONCLUSIONS: A previous diagnosis of hypertension was associated with TC. The use of external radiation for diagnostic and therapeutic procedures for tuberculosis probably explains the high prevalence of former tuberculosis in elderly TC patients. Treatment choices appeared to be influenced by the presence of comorbidity. Comorbidity did not affect survival up to 5 years; a study with a longer period of follow-up is needed.

Aged↗
PubMedDate not supplied

Takayasu's arteritis in Mexico: a clinical review of 44 consecutive cases.

OBJECTIVES: To review our experience in clinical diagnosis of the non-specific arteritis called Takayasu's arteritis (TA), and to assess its possible relationship with previous mycobacterial infections as judged by delayed hypersensitivity skin test. METHODS: We examined 44 consecutive patients in Mexico City. All of them fulfilled the ACR criteria for the classification of TA and had a characteristic panaortogram in the absence of any other arterial or systemic disease. RESULTS: Forty-three of our patients were Mexican mestizos; only one had a Caucasian appearance. 38 were women, and the age at diagnosis ranged from 15 to 64 years with a mean of 32 and a median of 35. Age at onset of the symptoms was under 30 years in most cases. Five patients had type I disease, and 4 had type II. Most had a diffuse arteritis (type III), and in seven cases involvement of the pulmonary artery (type IV) was recognized. All patients showed abnormal peripheral pulses and blood pressure differences, 35 had systemic arterial hypertension and 7 pulmonary hypertension. A noisy vascular auscultation was very common and cardiac ailments were also found in many cases. Systemic complaints such as fever, weight loss and malaise were present in the active stages of the disease. Arthritis did occur in a single case, arthralgia was frequent and inflammatory nodules involving the shin, perimalleolar area, and the antero-external surface of the distal leg were also common. Polyclonal hypergammaglobulinemia was a frequent finding in active and inactive cases; leukocytosis with neutrophilia, accelerated ESR and high fibrinogen, however, did occur when the disease was active. Eight of our patients had a previous diagnosis of tuberculosis, and 81% developed a delayed skin reactivity to PPD (2U old tuberculin). None had a bacteriologic diagnosis of tuberculosis or mycobacterial disease. CONCLUSION: Non-specific arteritis, or Takayasu's disease, frequently affects young women of colored race in Mexico. Late diagnosis is common and cardiovascular features dominate the clinical picture. Arterial compromise is widespread and may involve the pulmonary artery and its branches. Most cases are inactive and morbidity results from systemic arterial hypertension and heart disease; active cases have systemic complaints and laboratory abnormalities suggestive of ongoing inflammation. The close relationship between Takayasu's arteritis and previous contact with Mycobacterium tuberculosis was again confirmed in our series, although further studies are necessary to clarify this probable relationship.

Adolescent↗
PubMed1999

New insights into the Far Eastern pattern of mortality.

Some of the highest levels of excess mortality of males found anywhere in the world were present in several Far Eastern populations during the 1960s and 1970s but have progressively disappeared since that time. This study uses cause-of-death data to determine the diseases responsible for the existence and attenuation of these sex differences in Hong Kong, Singapore, and Taiwan. The results indicate that respiratory tuberculosis is the single most important underlying cause of the existence and attenuation of the pattern, that the role of liver diseases is not clear cut, and that other causes (such as cardiovascular diseases) are also important. A review of numerous risk factors yields no compelling reason why these populations experienced such large sex differences in mortality. However, it seems likely that public health and biomedical improvements (particularly those related to the reduction in mortality from tuberculosis) played a critical role in the attenuation of the Far Eastern mortality pattern.

Cause of Death↗
PubMedDate not supplied

Tuberculous meningitis in a renal transplant recipient.

Tuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immunocompromised patients, such as organ transplant recipients. We describe here a 66-year-old Turkish woman without any history of tuberculosis, who received a renal allograft transplant in 1994. After a pilgrimage to an endemic area for tuberculosis, she presented with fever and headache in August 1998. Clinical examination revealed positive meningism and hyperreflexia. Lymphocytosis was noted in her cerebrospinal fluid (CSF) and Mycobacterium tuberculosis infection was detected by PCR within the CSF. Despite immediate triple antituberculosis therapy, the patient's clinical condition deteriorated rapidly, with the development of septic shock syndrome, and she died three weeks after admission due to cardiovascular and respiratory failure. Mycobacterial infections, including extrapulmonary manifestations, should thus be considered in all renal transplant recipients presenting with unexplained fever. Preventive therapy, i.e. isoniazid prophylaxis, may also be recommended for patients risking exposure in areas endemic for tuberculosis.

Aged↗
PubMed2000

Calcific constrictive pericarditis: is it still with us?

BACKGROUND: The presence of pericardial calcification on a plain radiograph strongly suggests constrictive pericarditis in patients with heart failure. However, calcific constrictive pericarditis is considered rare in the United States since tuberculosis incidence has decreased, and doubt has therefore been raised about the importance of this radiologic finding in modern cardiovascular practice. OBJECTIVE: To determine the clinical and prognostic significance of pericardial calcification on radiography in patients with constrictive pericarditis. DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: A consecutive series of 135 patients (mean age +/- SD, 56 +/- 16 years) who from 1985 through 1995 had constrictive pericarditis confirmed surgically (n = 133) or by autopsy (n = 2). Patients were divided into two groups: those with pericardial calcification on chest radiography (group I) and those without (group II). MEASUREMENTS: Clinical and diagnostic findings were compared in both groups, and outcome was compared in 132 patients who had pericardiectomy. RESULTS: Pericardial calcification was seen in 36 patients (27%). The cause of constrictive pericardial disease was indeterminate in 67% of patients in group I and in 21% of patients in group II (P < 0.001). Patients in group I had had symptoms for a longer period and were more likely to have pericardial knock, larger atrial size, and atrial arrhythmia. Significantly more perioperative deaths were seen in group I, but incidence of late survival and incidence of noncalcific disease were similar in both groups. CONCLUSIONS: Pericardial calcification is a common finding in patients with constrictive pericarditis. It is often associated with idiopathic disease and other markers of disease chronicity and is an independent predictor of increased perioperative mortality rates.

Adolescent↗
PubMed1977

Tension pneumomediastinum.

Tension pneumomediastinum is an infrequently diagnosed but potentially fatal condition. The collection of air under pressure in the mediastinum compromises venous return to the heart and compresses major bronchi, leading to sudden and profound cardiovascular collapse. Although its mechanism was elucidated in the 1940's, when tension pneumomediastinum was most commonly a complication of tuberculosis, the same mechanism explains its formation in neonates with respiratory distress and in patients ventilated with volume respirators. Awareness of this condition will lead to more frequent diagnosis, but, more important, will also lead to prompt mediastinotomy and relief of this rapidly fatal condition.

Diagnosis, Differential↗
PubMed2005

[Health consequences of the tobacco epidemic in West African French-speaking countries and current tobacco control].

The burden of disease due to tobacco for each country will depend on the prevalence of tobacco use and the duration of the epidemic. Given that the tobacco epidemic in West African Francophone countries is relatively recent, the burden of disease due to tobacco use is currently low. However, tobacco related burden of disease in Francophone West African countries is increasing as the number of smokers continues to increase and the population has been smoking for a longer period of time. If the current trends continue, West African countries will be suffering the massive consequences of tobacco use in two or three decades. Apart from the classical health consequences of tobacco consumption such as certain types of cancer and cardiovascular diseases, there are some conditions of special importance in low income African countries such as the increased risk of tuberculosis infection and mortality amongst smokers, low birth weight for babies of smoking mothers, and tobacco consumption associated malnutrition especially amongst women. Furthermore, developing countries, with inadequate resources and other important health issues, cannot afford the costs of the chronic degenerating conditions caused by tobacco use, as these are very expensive to treat. Tobacco control in Francophone African countries is still deficient Human and financial resources which are often scarce in West African countries are dedicated to other health issues since tobacco is normally not amongst the public health priorities. Legislation in Francophone African countries is limited and not adequately enforced. A major reason for governments' inaction on tobacco is their fear of creating unemployment and loss of revenue from tobacco taxes. This fear is derived mainly from the arguments of the tobacco industry. Apart from lobbying governments, the tobacco industry uses all kinds of strategies to market their products in these countries and faces practically no barriers to their business in these countries. It is essential that Francophone African countries take immediate action and develop and implement comprehensive multisectoral tobacco control programmes. These programmes must be integrated into the existing public health programmes and make use of existing infrastructure and resources in order to stop the tobacco epidemic from expanding. In February 2005, the WHO Framework Convention for Tobacco Control (WHO FCTC) entered into force. Most Francophone African countries have signed the treaty thus expressing their intention to become Parties in the future. WHO urges these countries to become Parties as soon as possible and to implement the WHO FCTC provisions in order to control the tobacco epidemic. WHO in turn will provide guidelines and assistance for the process of becoming Parties to the treaty and implementing tobacco control measures outlined therein.

Africa, Northern↗
PubMed1990

[Analysis of the pathologic diagnoses of 1300 autopsies].

1300 autopsies in this hospital between 1949-1989 were reviewed, and the variation of the autopsy rate was analysed, giving an average rate of 20.7%. In 1258 cases with complete data, the consistency between clinical and pathological diagnoses reached 76.6%. Clinical misdiagnoses and uncertain diagnoses were found to be 19.2% and 4.1% respectively. The statistical figures indicated that infections diseases occupied a dominant position in 1950s, while in recent years cardiovascular diseases and malignant tumors have become the major diseases. Reasons of clinical misdiagnoses and lowering down of autopsy rate are discussed. Furthermore, statistical data cited in this article clearly demonstrate that autopsy is still of extreme importance in investigations of modern medical sciences.

Autopsy↗